Targeted Nipple Areola Complex Reinnervation in Gynecomastia Mastectomy: A Case Report

Abstract

Targeted nipple areola complex (NAC) reinnervation (TNR) to restore nipple and chest sensation has been previously described in patients undergoing breast reconstruction and gender-affirming mastectomy. A healthy 32-year-old male, with grade II gynecomastia with severe skin laxity and a BMI of 25 kg/m², underwent bilateral mastectomy with free nipple grafting (FNG) for persistent gynecomastia and chest wall soft tissue laxity. The mastectomy weight was 242.5 (range: 242–243) grams. Three lateral intercostal nerves (3rd, 4th and 5th) were preserved and directly coaptated to the new NAC on each side. Quantitative and patient-reported sensory evaluation was conducted at 18 months follow-up, revealing a median monofilament detection threshold of 3.61 (range: 2.83–3.61) at the NAC and 2.83 (2.83–3.61) at the chest wall as well as pain from pressure at a median of 100.0 kPa (range: 77.4–122.5) at the NAC and 151.5 kPa (range: 116.6–183.3) at the chest. While the median two-point discrimination was 3.0 cm (range: 1.5–4.0) at the chest wall, two-point discrimination could not be detected at the NAC. The patient was “very satisfied” with nipple and chest sensation and did not report any nipple hypersensitivity, nipple/chest pain, or phantom sensation/pain. TNR was able to restore various quantitative and patient-reported sensory functions at the NAC and chest with high patient satisfaction. This report provides the first quantitative sensory outcomes from TNR for restoration of sensation after mastectomy for the treatment of gynecomastia in a male patient.